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14100004CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10383 COLBY AVE CONTRACTOR: SERVICE CHAMPIONS PERMIT NO: 14100004 OWNER'S NAME: JENKINS DALE S AND FRANCESCA G 7020 COMMERCE DR DATE ISSUED: 10/01/2014 OWNER'S PHONE: 4089731506 PLEASANTON, CA 94588 PHONE NO: (925) 444-4444 Li LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ DUCT (E) FURNACE, SAME LOCATION (NO �j QREPLACE License Class V Lie.l V �� WORK) t� /�v c" t LOACM Date Contractor �Y'/C�LI�Pi I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $4476 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 31629021 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 RMTISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 RO LED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the sued ate: I l granting of this permit. Additionally, the applicant understands and will comp with all non-point source regulations per the Cupertino Municipal Code, Section 9 18. r O 4� Date Jt �1 RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business &'Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code,netns 25505, 2 33, 25534. I have and will maintain Worker's Compensation Insurance, as provided for by C/� R-(Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen Date:`/ 1 permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9 18. Signature Date CUPERTINO GENERAL PERMIT APPLICATION O� d EP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildinclCa�cupertino.org ` misc MIn TThInyTat-� 1Iz6LfPf34eNlrAT. I_IRT.Rr:TRICAI. nMISCELLANEOUS PROJECT ADDRESS ID -3 D-3 S-5 (i/��JSV A�PJN # I r7 y �! D Z OWNER NAME t -9 PHpNI� q I J' � -0( E-MAIL STREET ADDRESS o -,z ss ��' L (� CITY TA ZIP i r, �y �•CD 1 FAX CONTACT NAME�� Vt PHONE (1f S VID I EMAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER BUILDER ❑ OWNER AGENT ❑ CONTRAcToR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACT NAME LICENSE NUMBER (j ('7 O J/1 0 1 11 VV LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX ST?t RES (� C t '� 1� �►� 1 l sSg qtg ARCHTTECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAILFAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF JM SFD or DUPLEX ❑ MULTI-FAMQ Y BUILDINCr ❑COMMERCIAL PROJECT IN WI DLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLERHOME? ❑ NO DESCRIPTION OF WORK kp,�- 1 I "V"� TOTAL VALUATION: L oV By my signature below, I certify to each of the following: I am the property owner or authorizMagen�,,, n�-nm=,�bh�dfI have re�ths application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relator to uilding n. Io r resentatives of Cupertino to enter the above -identified perty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY WW p� a0 a OVER-fHE CCOUNTER 0 EXPRESS ❑ STANDARD LARGE 0 MAJOR MEPMiscApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO -PULP FQT-FMATOR - RITILDING DIVISION ADDRESS: 10383 COLBY AVE DATE: 10/01/2014 REVIEWED BY: MELISSA APN: 316 29 021 BP#: *VALUATION: 1$4,476 YPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC PERMIT TYPE: USE: h, /asp- llhwlb� h7sp. Fee: Fec' WORK (E) FURNACE, SAME LOCATION NO DUCT WORK) suppl, P'e­ �REPLACE SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced -Air IMFR=<100 1 # $143 $1 TOTALS: 143.00 NOTE: This estimate does not include' fees due to other Departments (ie. Fianning,'Pubac VVu N'.r Ire, aurettury Jv W., --i— ___ r___ ___ L—A __ q— availahle and are only an estimate. Contact the Dept -for addnl info. FEE ITEMS e Resolution 11-053Eff 7111131 104011, 1 QTY/FEE 'I a Y' Mech. Plan Check T001 hrs $0.00 Plr.ar t . 1111rin Checi l!'llec, Plan Check Mech. Permit Feer IMPERMIT Other Mech. Insp. 1 0.0 1 hrs L $48.00 Othei� PlYmb fnv� Li Lj h, /asp- llhwlb� h7sp. Fee: Fec' NOTE: This estimate does not include' fees due to other Departments (ie. Fianning,'Pubac VVu N'.r Ire, aurettury Jv W., --i— ___ r___ ___ L—A __ q— availahle and are only an estimate. Contact the Dept -for addnl info. FEE ITEMS e Resolution 11-053Eff 7111131 FEE QTY/FEE MISC ITEMS Plan Check Fee: T__= suppl, Fex PME Plan Check: $0.00 suppl, P'e­ T=_ PME Unit Fee: $143.00 PME Permit Fee: $48.00 consiruction Tlav: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 _Ilc'h°uwceol Plarming Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.58 Select an Administrative Item Bldp, Stds Commission Fee: IBCBSC $1.00 ... . ..... . $2 85.581 TOT $0. 0 0 TOTAL FEE: $285.58 Revised: 08/20/2014 STATE OF CALIFORNIA ALTERATIONS - HVAC CE4TIFICATE OF COMPUANCE MR ALT -03-E (-AI erations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -1R --ALT HVAC) (Page 1 of 1) Sit Address: L'01 b >4 -(2, Enforcement Agency: Date Prepared: 1D-l-ty Permit#: 1 *01700 y EgLipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Required R -value Conditioned Floor Area (sq'ft) Thermostat [3 P�ckaged System ❑Evaporator Coil AFUE COP ❑ R-6 (CZ 1,3-7) Ducts Served by system Setback (If not already ❑ S lit System ❑ Condensing Unit SEER HSPF ❑ R-91 (CZ 16) Ducts ❑ R-6 (all Ws) Plenums sq ft present, must F mace E3 Uneset EER ❑ R-5 or R7.5 Uneset' I be installed) H VERIFICATION SUMMARY installer determines work to be completed and matches to one of the options below. At permit application this fo is allowed to be filled out by hand. For final Inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. HVAC Changeout/Repair ' J1111'�;� Required Compliance Documents to be left on site for Final: include new. ducting AI Equipment, CF111-AL7-02-E Cc denser Unit; Evaporator Coil, CF2R: MECH-01, MECH-20-HERS Alr Handler/Furnace CF311: MECH-20-HERS In taller Requirement: Duct leakage (,5_15% or,:L10%to outside, or seal all accessible leaks) Exempted from duct leakage testing If. - f:1. 1.Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned s ace, or ❑ 3. Existing ducts ems are constructed, insulated or sealed with asbestos list manufacture date of building ❑ 2, New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts CFIR ALT 02-E CF211-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS CF311-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24}HERS= In!otaller Requirement: Duct leakage: 6%, Fan Efficacy (.58W/CFM), Air Flow 2 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: I dudes replacing or Installing All New CF1R-ALT-02-E Cu; and one or more of the following: CF211-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS Condenser Unit, Evaporator Coil, Furnace CF311-MECH-20-HERS, MECH 23 or 24) -HERS Installer Requirement: Duct leakage 16%, Air Flow Z 350 CFM/ton (or Standards Table 150.0-C / D alternative) 1 ❑ Exempted from duct leakage testin g I existing duct systems are constructed, Insulated or sealed with asbestos. ❑14. New Ducting over 40 feet R uired Compliance Documents to be left on site for Final: i Adding or replacing ducts in unconditioned CFiR-ALT 02-E s ce but less than All New Ducts= CF2R: MECH-20-HERS CF3R: MECH-20-HERS Ing Iler Required to: Dud leakage (<15% or, S.10% to outside, or seal all accessible leaks) ❑ Exem ted from duct leakage testing 1 existing dud systems are constructed, insulated or sealed with asbestos. Ail new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc. : A New Dud system Is when the duct system is constructed of at least 75 percent new duct material, and up to 25 percent may consist of reused p acts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, dud material. ' R-5 (Y thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for Iinesets over 1 inch. Most mfg will require Suction line Diameter T with insulation as the follows 2.5 -2T -2W, 2.5-3T-2%", 3.5 to 4T -W, ST -4%" Contractor (Documentation Author's /Responsible Designer's Declaration Statement) 1 'ertify the following under penalty of perjury, underthe laws of the State of California: i The information provided on this Certificate of Compliance is true and correct. 2 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility. for the information on this document. 3.i That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Tide 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4 That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR. S. The building design features or system design features identified on this Certificate of Compliance are consistent with the Information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building it application. Rdsponsible Designer Name: a V i � �. Respons' Design Signature Date signed: l D -1 W Uame: $11 O L1 ny:Address: ` f� u�uryt H9ns '- & i�(` P �teq�Zaw oA j%Iq Phone- �zs `l�q-�jyy`l For assistance or questions regarcung tee Energy Standaras, catiact me energy nvsnne aa: arow-i i�-a�vv SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 CUPERTINO (408) 777 -3228 •FAX (408) 777 -3333 • buildinaC�cupertino.org Address FILE -- %4 /10)A,"yl(� PURPOSE This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single- family and multi- family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Signature......................................... ..........................Lic.# ....... ............................... Date: ................... Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CSC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: ha dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. k i rnnr, nnr4 onran fn 11e)M.F1X1Aath the tarm.c and conditions of this statement Smoke and CO form.doc revised 03118114 op. - owner (or Owner Agent's) Name: Date: Signature ...... ...... .... ... ......... .. ................ Contractor Name: Signature......................................... ..........................Lic.# ....... ............................... Date: ................... Smoke and CO form.doc revised 03118114 op. CUPERTINO Owner Name Address WATER - CONSERVING PLUMBING FIXTURES FILE OWNER CERTIFICATE OF COMPLIANCE 7& COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 - buildingCcupertino.org W Permit Nn_ Please refer to the attached California Civil Code Sections 1101.1 - 1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: o Go to Question 2. Date: 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water - conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply., ❑ The licensed plumber's certification has. been provided to the Building Division. Sign below and skip the rest of the form Owner' Signature: )X 'No Go to Question 3. Date: 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: �No Go to Question 4. Date: 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: ❑ Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. ❑ My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non - compliant plumbing fixtures to be replaced with water - conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non - compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water - conserving plumbing fixtures. On or before January 1, 2019, all non - compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water - conserving plumbing fixtures. SB4072014.doe revised 03118114 On or before January 1, 2019, all non - compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or ­n­— -in—Wovements). 11We, the owner(s) of this property, certify under penalty of perjury that non - compliant plumbing fixtures have been replaced with water - conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Gree ilding Standards Code, and manufacturer's installation requirements, and that the water- conservine nlumbine fixtures with the reauiYanents as indicated in the table below. Owner's (or Owner Agent's) Signature: ,Z& Z , 1,fZZI Date: f/- U -TW 11 Upon completing and signing this Certificate, please retumgfto the Building Division in order to final your permit. 1. If the existing plumbing fixture water usage /flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2014. doc revised 03118114 Non - Compliant Water- Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single- Family Multi - Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons /flush (Toilets) Gallons /flush Dual flush toilets: 1.28 gallons /flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons /flush Gallons /flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand -held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and /or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets - Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets - Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage /flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2014. doc revised 03118114